HomeMy WebLinkAboutALPINE TERRACE BLK 1 LT 5
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191397 PID Number: 015-243-29
Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Upgrade
Name
EDWARD NELSON
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
7561 SOLDOTNA DR
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
ALPLINE TERRACE BLK 1, LOT 5
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ftz
Ft.
Well
100'+
50'+
TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
GREER TANK 1250 Gal.
Surface Water
100'+
Material
Number of compartments
Lot Line
10'+
NA
PLASTIC
TWO
Foundation
10'+
LIFT STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Electrical installed by
Installer
PIPE MATERIAL House to tank 3034Tank to 3034
drainfield
MIKE N ANDERSON, P.E.
Drainfield 3034 CO/MT3034
Inspector MIKE N ANDERSON, P.E.
BENCH MARK (Assumed elevation) 100 ft
Inspect
15' 9_16-19
Location and description
2ion
nd
3rd
STAIR LANDING,
4th
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Ir �{
'�•
Conditional Approval:
• ^
•.���,
Date00
�P�•'e
sea°� • • • • o o s • • o • • • e e
• e ° •• •••• • •••.�o •a.. e• e o
Septic _
Approved '►�� (~ Date — ��
MICHAEL N. ANDERSON ;� d'
�'• CE- 467 `41-4
ddb F • �f 7IC
Note: this approval does not include well permit requirements.
@��(]FESSia�®`�'
k - VIII VL/ 1 UB
Permit No. OSP191397 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: ALPINE TERRACE BLK 1, LOT 5
MARK
A
B
C01
20
40
CO2
21
41
TC01
25
48
TCO2
30
54
CO3
35
61
C04
35
62
NEW 1250 GALLON PLASTIC TANK
CO3 TCO
02
C01
4TC01
PID No.: 015-243-29
i
i
i
i
/
/
�\ I
�i
I \
1 \
1 \
\ \ EXISTING WELL
\ 1
\ i
\ I
\I I
1\
/ \ ----
� \EXISTING ELL / \
\
BENCH, GARAGE SLAB/ \ \
� 2 i
— AL BUILT
—seA
CO2 CO3 ®®®®ae�®®
M1
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AV Air 49TH e�'V®®0
94 7.250 GALLON 7 ............��.. N...:.....•• ...............0
PLASTIC TANK
_VK
pper�.
MICHAEL N. ANDERSON.- Q1 Ar
®A '. No. E 469A.441®
Air
SEPTIC SECTION
N.T.S.
N'C!i• frY MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Program �� 5�;
' 7111 PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 �V
i7" http://www.muni.org/onsite
Department
ANCN OR:6
On-Site Wastewater Disposal System Permit
Permit Number: OSP191397 Effective Date: 9/6/2019
Work Type: SepticTank Upgrade Expiration Date: 9/5/2020
Tax Code Number: 01524329000
Site Legal Address: ALPINE TERRACE BLK 1 LT 5 G:2740
Site Mailing Address: 7561 SOLDOTNA DR, Anchorage
Owner: NELSON EDWARD & ETHEL LIVING Lot Size in Sq Ft: 68700
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: /7//k)
��/ Date: / 6 C
Issued By: /,6— (.1 Date: 9/f'u
/ .4
MUNICIPALITY OF ANCHORAGE
Ii
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 7-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION 401111111111111.1.
Parcel I.D. 015-243-29
Property owner(s) NELSON EDWARD & ETHEL LIVING TRUST Day phone 72? - M 271.
Mailing address 1300 NE 16TH AVE APT#353, PORTLAND, OR 97232
Site address 7561 SOLDOTNA DR
Legal description (Sub'd., Block & Lot) ALPINE TERRACE BLK 1 LT 5
Legal description (Township, Range & Section)
Lot Size 68,700 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(IE all that apply)
Absorption Field ❑ Initial ❑ Single Family (SF) x
(w/wo ADU)
Septic Tank Upgrade Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple :ITri •s ,o ❑
Privy ❑ ( .•. or D) >>
Private Well ❑ RYAN
Water Storage ❑ SEP Q ,; �Jf9
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: `' ti
ar g8 - gyp
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
/1ML
(Signature of property owner or authorized agent)
Permit/Rush Fees: 36Waiver Fees:
Date of Payment: q/b19 Date of Payment:
Receipt Number: SC/23/5- Receipt Number:
Permit No. (15PI 9134 Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
August 31,2019
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: New Septic tank permit
Legal: ALPINE TERRACE BLK 1 LT 5
To Whom it may concern:
This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact
any of the neighbors or encroach on any wells, septic or open water issues.
Sincerely
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
I
_' 7 r
UTILITY PROPERTY LINE—/1
EASEMENTS-1-\\I --
/
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CONCRETE CRIB AND /
LEACH FIELD i/
I/
n
/f \ 1
`
I
/ R&R NEW 1250 GALLON \`\
PLASTIC TANK W/20" \
/ RISER \
\
1 \
)4\ DCO EXISTING WELL
Z\,%� TCO ```` �.;00'RADIUS
NO WELLS OR (`' `,``` \\ 1\
OPEN WATER J \\ �```1 \\� 11
WITHIN 100' ( p, �� \\\ 11
EXISTING ® \\f\
•
HOUSE / 1
� .:.: .. I
� DRIVEWAY..: ..•. :"• . • i
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\ EXISTING WELL
`\\�100'RADIUS O /
/
• Vii' •
--- •...-. /.
/ ./-.
i EXISTING WELL �\
i� 100'RADIUS
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Septic Tank Replacement o`ssiisik1
NELSON EDWARD & ETHEL LIVING TRUST ��4 0 q��s�.♦♦
•
G' 1 ' °i
ALPINE TERRACE BLK 1 LT 5 ;•• 49TH %,\ : , �0
Anchorage, Alaska • • •
i
Michael N. AndersonP.E. DATE: 9/2/2019 .O.'")%.°
';MICHAEL N. ANDERSON; `�•
�O ma�S3y;;���� No. 9469 r NIF
4601 NATRONA AVE DRAWN: DJR ��j"�`, •.,9 ;f1¢ . •
ANCHORAGE,ALASKA 99516 • ICO �•
(907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=50' le441, 55` i4
--' ,' GRAPHIC SCALE. 1 Inch — 40 Feet
20 0 20 40 80
\ - O
e e 4 0
o '-\(-) ��,� /,
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,' 2p /
/ Op', ,
/
A-100' WELL RADI OJ
SHED / /
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36.4 I 1. .
\\ �OD 4
\ \\ �N `•' WELL; /
>- 1. 3
\\�p�oG�\\ 7 o w A i�
\ \ �jASPHALT
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N 54°54'00" W 264.88 30 : .
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CURVE CHART \\ \\ Air
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NO DELTA RADIUS LENGTH \\ \ /A �'
0 30'33'26" 210.00 112.00 \ /:),4•. ��'N 7 ,
.
Date Scale Legal Description / .. .�'f�/ t
7/29/2019 1 = 40' I hereby certify that the property described hereon has been surveyed I '
BOBBY F. BURNETT Grid b me, or atm direction, and that the improvements situated thereon BOBBY F. BURNETT
LOT 5, BLOCK 1 are within the property linea and do not overlap or encroach on the `" IS-5484 /
2941 Carriage Drive SW 2640 AS BUILT ALPINE TERRACE property lying adjacent thereto unless otherwise shown. That no CPV LQ —/, e.
Anchorage, Alaska 99507 improvements on the property lying adjacent thereto encroach on the 1b ' '
(907) 350-5541 Drawn by Field Book SUBDIVISION premises in question and that there are no roadways, transmission , '"EssIONALAir-_...)
\ BFB ASB2019 PLAT # 64-63 lines or other easements on said property except as shown. �`__1111/IP
( MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
· ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME IPHONE ! []NEW
MAI LING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
DISTANCE TO: ~ Well ~ Absorption area Dwelling PERMIT NO.
~ Z Manufacturer Material No. of compartments
Liq. capacity in gallons Inside length Width Liquid depth
IF HOME,DE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~ ~ ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundati~ Nearest ~e PERMIT NO.
' ~ lines/ Length OZ2 ~ Total leng~
N~ ~2 ~ ~ No. of , i~. Trench width~nches. ~ ' Distance betwe~/~lines
~ ~ Top of tile to finish grade ~ ~, Material beneath tile ~ ~/' inches Total effectiv~
Lengt~ ~ ~ Width ~ ~ ~ Depth ~ ~ .... ~ ' / ~ ~ PERMIT ~0.
· r~ ~1~ i~V-~ ~~
Type of ~rib Crib diameter Crib depth ~ Tnt~l ~ff¢ct~,~ % --
~ ,-, ~~. ~: _- · _
~CE TO: ._.~ell ~ ~ ~ I Buildin~un~ation_~_ Nearest lot I~ ~"~ ~ t
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOl L TEST RATING ,
/
REMARKS ., :~',
.': /
,. ?:-~. ,, .? ', ,
A~VED ~ ~ ~ ~ DATE LEGAL
3)
PERMIT NO.
1"-11_1tI IC:I F"j''-_ I T"T' IDF
DEPARTMENT OF'..,_~LTH 8ND ENVIRONMENTAL Pti :.CTION
825 "L" STREET, ANCHORAGE, Ag:. 99501
264-4?20
CIFi--LS I TE SE[4EE: IJF'I3E:RB.E F'EF:1"fl IT
( 780545 )
APPLICANT
LOCfTION
LEGfL
DORWIN SMITH
L5 B1 8LPINE TERRRCE S/D
SR BOX 929 (PALMER) 99645
LOT SIZE
0 SQUARE FEET
TYPE OF' SOIL 88SORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4
SOIL RATING (SQ FT/BR)= 160
'THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
[:,EF'TH= 10 L EI'-,IG T H= 54 G F-.' FI "..-' E L [)EF'TH= ~
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIEL. D.
THE DEPTH OF 8 TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND 8ND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
8ND THE BOTTOM OF THE EXCAVATION (IN FEET).
F'ERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTBLLATICIN INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TbJm2m (2) I r4SPEC:TI Cmr-~--~- I~RE E:EIZ~I_II FCE[)
88CKFILLING OF 8NY SYSTEM WITHOUT FINAL INSPECTION AND flPPROV~L BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL 8ND 8NY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL; OR
150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS 8RE
AVAILABLE TO INSURE PROPER INSTALLATION.
F' E !-~: M I T E ::--'. F' I I~: E S [:, E C: [-: I"1 B E R 2-: 1 .. ::L La ,---'"
I CERTIFY THAT
±: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED:
APPLICANT DORWIN SMITH
ISSUED BY ..... DATE. Vg. 2
PERFORMED FOR:
o
I* EGAL DESCRIPTION:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pough 6~50,' Anchorage, Aladm 99502 276-222f
SOILS LOG -- PERCOLATION TEST
~D/~I~J ~ ~'1~' DATE PERFORMED:
SLOPE $II~- PLAN
~, SOl I.~ LOG
PERCOLATION
TEST
I0 -~5 -77
10
11
12
13
14
16
16
17
18
19
2O
"~1~....~ f ~.'~/ WAS GROUND WATER
~,L,,g~l,/~' (.~ I~ ~ '~ ENCOUNTERED?
IF YES, AT WHAT.
DEPTH?
$
O
P
E
Gro. Net Depth to Net
Reading Date Time Time Wat~ Drop
PERCOLATION RATE 101~ll4/ll~. (m~nutes/jnch) : I~L' ~'
TEnor RUN BETINEEN -- FI' AND
COMMENTS
PERFORMED BY: -~ ILVP_~2.'~
72~ (7/'/e)
DEPARTME~
825
~.~LbNICI?ALiTY OF · ~E--~ ~SO1 O~ /~
L Street, AnchoracJe. Alaska 99 264-47~0
Date Received: September 20, 1977
#1: Time
Date
9: ~0/a.m. #2: #3:
_77 Wednesday Date
InspWil~s Insp ~~j~,~/7~~. Insp 6~//,,,
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request:
Mailing Address:
Phone:
2. Property Owner: Dorwin R. Smith/Jackie De Jonq Phone: 344-0777
Mailing Address: Box 4-211 Anchorage 99509
3. Legal Description: Lot 5 Block 1 Alpine Terrace Subdivision
4:
Single Family Residence: (
Multiple Family Residence:
Number of Bedrooms: Four
Number of Bedrooms:
5. Well System: Individual well ~ Cou~unity/Public System ( )
Permit # Depth of Well
Construction
55' Well Log on File ( )
Bacterial Analysis
Sewage Disposal System:
Permit
Septic Tank Size
Absorption Area
On-site System
Public Utility ( )
Installed ~ i~Installer 7
¢~ Manufacturer
Soils Rate
Distances: Well to Septic Tank
Nearest Lot line
to Sewer Line
to Nearest Lot Line
Material
to Absorption Area
Absorption Area
..' '~ ' I ~,,,~NICIPALITY OF ANCHORAGE -' "
~/~~ / Department of Health and Environmental Protection..
//$~~/ ~ 825 L Street, Anchorage, Alaska 99501
'. lities
uest for Approval of Individual Sewer and Water Fa~c.l~
1. Property Owner: ~/-~-~ ~,_ ~/'2~'~// $ ~(~"Lr ~cz~
Mailing Address:
Phone:
0
Name of Buyer:
Mailing Address:
Phone:
o
Lending Institution:
Mailing Address:
Realtor/Agent:
Mailing Address:
Phone:
5. Legal Description:
Street Location:
Phone:
e
Single Family Residence:
Multiple Family Residence:
Number of Bedrooms:
Number of Bedrooms:
Water Supply: *Individual Well (~)
If Individual Well, well depth
If Community System, name of system
Public/Community System ( )
Sewage Disposal System: On-site System
If On-site System, date of installation:
(~) Public System ( )
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77
,, Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 5 Block 1 Alpine Terrace Subdivision
· f. ~ :-, . [ ...
Letter Attached: ( )
Date:
Disapproved:-_~-~~.
Department Worksheet:
October 13, 1977
Dorwin S~/th
Box 4-211
An=borage, Alaska
99509
Individual Sewer Facility ~n Lot 5 Block 1
Alpine Texra~e Subdivision
An adequacy test was =on~ted by this department on the
above subject property. This test showed the sewer system
to be inadequate for a four(4) bedroom resiaence.
This department will require the sewer system to be upgraded
before approval is give~ for the in~ividual sewer facilities.
A soils test(as explained in the enclosed hanaout) will need
to be obtained and a permit issued by this department for
an ~n-site se~r system before any upgrade is started.
This department will grant an interim approval of the sewer
facilities upon the receipt of a soils test and the issuance
of a permit if sufficient fun~s are e~r~wed to cover the
cost of the upgrade an~ any ~nterim pumping of the septic
~k that ~ay be required.
If there are any further questions, please contact this office
at 264-4720.
Sincerely,
Cory Willis, R. $.
Sanitarian
CW/ljh
2EATER ANC~tORgGE /~REA BOROUGH
!'.~3LTH D£P~R~MNT
327 EAGLF. STREET
~NCHORAGF~ , ALASKA 99S01
279-2511
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
FOR
1. Approval Requested By
Address .} ~ .4 /'
2. Property Owner ~/~ _ (_ Phone
3. Legal Description~_,: ~ % J~/,'("/
So
Well Data:
A. Type
B.
C.
D.
/~,// /4 f I
Construction ~/-i-~
E, Bacterial Analysis
A. Septic Tank (If homemade, show diagr~ on back)
1. Size /f~:
2. Age
3. Nanufacturer , ,
Installer
Water Facilities
~prova! Request for Se~
Pag~e_Tw~
B. Seepage Pit
1. Size
2. Lining. ~:,~-.~(~, ,,t~
C.. Disposal Field
"' 1. Numbe~ Lines
Requ~;edT~al Leasure~ent~~
A. Nell to Septic Tank
B. Well to Seepage Pit..
C. Well to Sewer Line
)..ell to Property Line
E. tVell to Other Possible Contan~nation
F. Foundation to Septic Tank ~
G. Foundation to Seepage Pit '7~
Seepage Pit to Property Line
8. CO~ENTS:
,
APPROVAL VALID FOR ONE YEAR FROrI DATE SIGNED.
DISAPPROVED:
GREATER ANCHORAGE AREA BOROUGH HEALTH DEPART~/IENT
EDll70 /
MUNICIPALITY OF ANCHORAGE
Development Services Department4 Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-243-29
1. GENERAL INFORMATION
Expiration Date: C V Z2
Complete legal description Alpine Terrace, Block 1 Lot 5
Location (site address) 7561 Soldotna Drive
Current property owner(s) Bryan Anders Day phone (907) 733-9321
Mailing address 7561 Soldotna Drive, Anchorage, AK 99507
Real estate agent Gary Cox Day phone (907) 727-4279
2. TYPE OF DWELLING:
E Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Q
Private Septic
Q
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 55C)
Date of Payment
Receipt Number
COSA # 0 SC221 3 G -Z
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
Distance:
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date 7/15/22
,q�:9��i
i y�P TH
6. DSD SIGNATURE . • . , : • • ; '
System #1 Approved for bedrooms / Benjan r /Schiller
System #2 Approved for bedrooms CE 12592
Disapproved PROF
Conditional
Conditional approval for bedrooms, with the following stipulations:
INN
pWA ON y
m
rFR m
By: Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: Alpine Terrace Block 1 Lot 5 Parcel ID: 015-243-29
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled UNKNOWN
Total depth 55* ft
Cased to LINK ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 7/12/22
Static water level at beginning of test 6 ft.
Comments Well depth taken from muni file.*
B. TANK DATA
Age of tank(s) 2 years
Tank type/material SEPTIC/PLASTIC
Measured operating fluid level in septic tank 49
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 7/21/22 McDonald's Pumping
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9/16/19
❑ ALL standpipes present per record drawing
Total measured depth from grade 11.2 ft (max)
Measured depth to pipe invert from grade 4.0 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective N/A
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced N/A gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Well production at time of test 6.7 gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 6.65 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 6/28/22
C. LIFT STATION
uired maintenance completed
Age of lift sta years
Lift station material
Comments:
Adequacy test date 7/12/22
Results F✓ Pass For 4 bedrooms
Fluid depth prior to test 51 in
Water added 869 gal
New depth 70 in
Elapsed time 1440 min
Final fluid depth 42 in
Absorption rate '600 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date N/A
N/A
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
QQ Yes
Neighboring Tank > 100' Yes
Absorption Field on Lot > 100' Yes
Neighboring Absorption Fields > 100'
El Yes
Community Sewer Main > 75' R Yes
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft Surface Water > 100'
ft
ft
ft
ft
ft
Yes if No ft
Property Line > 5'
L-�] Yes
Community Sewer Manhole/Cleanout > 100'
if No
ft
0 Yes
if No
if No
ft
Private Sewer/Septic Line > 25' Yes
if No
if No
ft
Holding Tank > 100' 0✓ Yes
if No
Water Service Line > 10'
0 Yes
Animal Containment > 50' F1 Yes
if No
if No
ft
if No
ft
Manure/Animal Excreta Storage > 100'
if No
ft
❑✓ Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft Surface Water > 100'
ft
ft
ft
ft
ft
Yes if No ft
Property Line > 5'
L-�] Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
F-11 Yes
if No
ft
Private Wells > 100' ❑✓ Yes if No _
Water Main > 10'
0 Yes
if No
ft
Community Wells > 200' 0 Yes if No _
Water Service Line > 10'
0 Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' El Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
El
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
0
Yes
if No
ft
Private Wells > 100' El Yes if No
Water Service Line > 10'
0
Yes
if No
ft
Community Wells > 200' Yes if No
Surface Water > 100'
a
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that l have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
or -Ikk
oTH
......,
Benjarri ySchiller
CE 12592
�i ��'���• , 07/15/22 , •11�UAw
pROFESSt0� -�
ft
ft
ft
10
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC 221362
Subdivision: Alpine Terrace B 1 lot 5
A water sample revealed a nitrate concentration of 6.65 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
,
Mailing Address P O Box 196650 * Anchora a Alaska 99519 6650 *www muni or
3 � .
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical' methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
`Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org
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�MIUMICIDPALITY OF
Development Services Department'`
On -Site Water & Wastewater Section
ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval O�
Parcel I.D. 015-243-29 Expiration Date: I �'��"I
1. GENERAL INFORMATION
Complete legal description ALPINE TERRACE BLK 1 LT 5
Location (site address) 7561 SOLDOTNA DR, ANCH AK
Current property owner(s) NELSON EDWARD & ETHEL LIVING TRUST Day phone
Mailing address 1300 NE 16TH AVE APT #353, PORTLAND OR
Real estate agent Day phone
2. TYPE OF DWELLING:
A suldo
b 7 8 9 70
❑ Single Family (w/wo ADU)ti
)?ILD
4
Vc,
� �
Russ' i
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
SEP 2 4 201 A
3. NUMBER OF BEDROOMS:
4
�ti
� 0[ C nn
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWA SAL:
Private Well
FX I Private Septic
El
Water Storage
❑ Holding Tank
❑
Community Well
❑ Community
❑
Public Water System
❑ Public Sewer
❑
Waiver request for:
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee
Waiver Fee $
nn
Date of Payment `7 ��y�/ !
Date of Payment
Receipt Number ta3a��
Receipt Number
COSA # 65 C Iq I q5_2
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE ANCH AK
Engineer's Printed Name MIKE N ANDERSON, P.E. Date 9-23-19
-meq OF
low
49TH+ "•;�
6. DSD SIGNATURE °' ° °' • • ° ° •
...
System #1 Approved for 4 bedrooms •�
MICHAELN: ANDERSON
/ System #2 Approved for bedrooms ���!1�.•• 9 -� 69 •,.\��
Disapproved `AFD • ?• �� �• ° •�;���
�t®®® Q, ESS10��4���
Conditional approval for bedrooms, with the following stipulati3O)8s '0_��
G\pw r
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Q A rkg,tzn
p P N TQC
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B `'�-�` Original Certificate Date: S l
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: ALPINE TERRACE BLK 1 LT 5
Parcel ID: 015-243-29
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
Adequacy test date 8-25-19
❑ Well log is filed with Onsite (or attached)
Well production at time of test 5+ gpm
Date drilled UN
Water storage tank volume 0 gallons
Total depth 55* ft
Well disinfected for coliform test? ❑ Yes ❑ No
Cased to UN ft
❑ Coliform bacteria is Negative
❑ Sanitary seal is functioning correctly
Nitrate 0.462 mg/L ❑ Nitrate less than MRL (ND)
❑ Wires are properly protected
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) 12 in.
Collected by MNA
Date of flow test for COSA 8/25/19
Date of Sample 9-5-19
Static water level at beginning of test 40 ft.
Any rejuvenation treatment (past 12 months)
Comments * NO WELL LOG BUT DEPTH STATED ON MOA DATA SHEET
If yes, enter date
B. TANK DATA
Age of tank(s) 2019 years
Tank type/material PLASTIC
Measured operating fluid level in septic tank NEW
❑ Standpipes/foundation cleanout per record drawing
Date of pumping NEW TANK INSTALLED
D. ABSORPTION FIELD DATA ORIGINAL 1965 SYSTEM TESTED
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Which system tested (date installed) 1965
Adequacy test date 8-25-19
7 ALL standpipes present per record drawing
Results ❑✓ Pass For 4 bedrooms
Total measured depth from grade 12.4* ft (max)
Fluid depth prior to test 14 in
Measured depth to pipe invert from grade 4'+ ft (min)
Water added 600+ gal
❑ N/A — pressurized field
New depth 17 in
❑ Monitor tubes go to bottom of effective. If not, state
Elapsed time 1440 min
depth into effective
O Code -required soil cover over field
Final fluid depth 14 in
❑ System presoaked
Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months)
date of test)
Gallons introduced 0 gallons
If yes, enter date
Comments/Deficiencies: ` PUSHED TAPE TO THE BOTTOM OF THE SEEPAGE PIT
COSA Checklist yellow sheet
WN
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Yes
Community Sewer Manhole/Cleanout > 100'
F/ Yes
if No
ft
M Yes
if No
Neighboring Tank > 100' M✓ Yes
if No
ft
Private Sewer/Septic Line > 25' M Yes
if No
Absorption Field on Lot > 100' [D Yes
if No
ft
Holding Tank > 100' M✓ Yes
if No
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' Yes
if No
0✓ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0✓ Yes
if No
ft
[D Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ✓❑ Yes if No ft Surface Water > 100'
ft
ft
ft
ft
ft
[Z] Yes if No ft
Property Line > 5'✓�
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
F/
Yes
if No
ft
Private Wells > 100' Yes if No
Water Main > 10'✓1
Yes
if No
ft
Community Wells > 200'✓0 Yes if No
Water Service Line > 10'
[D
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓0
Yes
if No
ft
Private Wells > 100'
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200'
Surface Water > 100'✓Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
ft
ft
❑✓ Yes if No ft
Q✓ Yes if No ft
.. m m •. s a m f ®e ®o a o
MICHAEL N. AND,'RSCtd�„.
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